“This was our first experience of the Hospice. We found the
care, support and commitment provided by all staff and
volunteers to be of the highest quality. You gave our dad,
husband, brother, dignity and respect at a difficult time in his
life and we cannot thank you enough for that.”
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Statement from the Chief Executive
Page 3
Our vision, purpose and values
Page 4
Summary of Services
Page 5
Priorities for Improvement 2014/15
Page 6
Other Improvements in 2014/15
Page 9
Clinical audit, Hospice Activity and Complaints
Page 12
Accidents and Incidents, Key Quality Indicators
Page 13
Patient and Family Experience
Page 14
Priorities for Improvement 2015/16
Page 14
Statements from the Care Quality Commission
Page 15
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The care The Hospice of St Francis provides is very special. Our dedicated staff team work tirelessly to ensure we
provide a secure, safe and welcoming environment at the Hospice to look after those with life-limiting illnesses and
are active in improving end of life care for all in our community.
The Inpatient unit is always busy and occupancy of our 14 beds is at 88% with the number of non-cancer patients
continuing to rise. Our clinical team receives continuous training and education to ensure they are able to advise on,
and implement, latest developments in palliative care. This is vital as we are seeing more patients with complex
physical, psychological and social requirements and need to provide appropriate support.
This year, we have working even more closely than ever before with GPs, district nurses and our local hospitals to
share best practice and work collaboratively to ensure that everyone in our catchment across Hertfordshire and
Buckinghamshire has access to good end of life care.
We remain committed to maintaining our high standards and rigorous quality control in order to continue to deliver
our exceptional care in all areas of Hospice life.
Charles G Toner
Chairman of the Board of Trustees.
I became CEO at the Hospice of St Francis in March 2015 and witnessed at first hand the outstanding
compassionate care that the team of professionals and clinicians give to our patients and their
families. I am very proud of the commitment of all our staff to constantly improve the way we care for
patients with life limiting conditions, their families and friends.
Our staff, volunteers and Trustees have developed our values which are fundamental to everything we
do. We now use these to underpin the recruitment and selection criteria for all our new staff and
volunteers. Our values are listed later in the report and they reflect the quality of care you will see in
this document.
We are in the process of implementing new governance structures through my new Executive Team
who are responsible for the senior management and leadership of the Hospice.
I believe that we demonstrate through this report our performance for last year and our plans for the
next 12 months. This has been endorsed by our Board of Trustees and is, to the best of my knowledge,
an accurate description of the quality of care at The Hospice of St Francis.
Steve Jamieson, CEO
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The Hospice of St Francis Quality Account provides an opportunity for all stakeholders to monitor and openly
scrutinise the process by which we seek, year on year, to improve the quality of the services we provide.
Our Quality Account is an annual report of –
 An introduction to the Hospice of St Francis Clinical Governance, our services and our commitment to quality
 Our progress on last year’s priorities
 Looking forward and setting our priorities for the coming year 2015/16
Development of our quality priorities 2015/16
Improving quality is a high priority for the Hospice of St Francis and it is important that we are able to develop
meaningful quality indicators that we will identify for future development so that they can be monitored, reported
and scrutinised by all.
Quality Account Governance Arrangements
The Director of Care and Clinical Development has the responsibility for the content of the Quality Account and this
is overseen by the Chief Executive and the Board of Trustees.
The Hospice data quality is assured through audit processes both internal and external.
Our vision is of a community where people live well until the end of their life and where nobody dies afraid or in
pain.
Our mission is to transform the experience of illness and death, through care, education, innovation and engagement
with our community.
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Be at the heart of communities
Respond to personal preferences and needs
Deliver high quality and holistic accessible care
Be effective and use resources efficiently
Influence the quality of care through education
Collaborate with other health and social care providers
Enhance the capacity and resilience of communities through volunteering
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Following consultation with our staff and volunteers the Hospice Values were developed and shaped and are now
embedded into every aspect of hospice life.
Respectful Relationships
We create a caring and compassionate environment: demonstrating appreciation and respect in all our interactions,
and taking account of individuals’ needs and circumstances.
Constructive Communication
We encourage open, clear and honest communication, where everyone can be heard.
Excellence through Innovation
We strive for excellence in everything we do; encouraging innovation, maximising opportunities and exploring fresh
ideas in order to see continuous improvement.
Integrity and Trust
We act with integrity, building trust by demonstrating our loyalty to the Hospice, its people, aims and vision.
Encouraging Learning
We educate and develop to enhance knowledge and skills, improve performance and help people reach their
potential.
Sustainable Service
We aim to provide a professional and sustainable service, which is fair, efficient and co-ordinated.
Community Engagement
We involve and engage with our community, building mutually supportive relationships which maximise our
contribution.
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Inpatient care (14 beds) – which provides 24 hour care and support by a team of specialist staff
The Spring Centre – this provides wellbeing and rehabilitation services to patients with stable and advancing
illness, their carers, family and friends
Outpatient service – consultations with a doctor, clinical nurse specialist or therapist
Community services – which provide specialist support and advice in a patient’s home or in a care home
Education – to promote excellent hospice care within other settings
Bereavement Care, including support for children.
Doctors including medical consultants
Nurses and healthcare assistants
Therapies to support independence and promote comfort including
o Physiotherapy
o Occupational therapy
o Complementary therapy
o Creative arts therapists
Social workers provide specialist support and counselling
Spiritual care services supporting patients and their families
Bereavement services for adults
Children’s support team to provide pre- and post-bereavement support
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In 2014/15, the Hospice planned to address the following key priorities for improvement in each of the quality
indicators.
1. Patient safety
In 2014/15 we said we would improve some of the processes around patients’ nutrition and improve infection
control. The following steps have been taken to address this:
Nutrition
The Nutrition Matters Group was formed with clinical staff and kitchen staff to discuss nutritional issues regarding
patients’ needs. This group discussed the need for protected mealtimes for patients, and for a better internal system,
with help from the kitchen volunteers to record patients’ preferences and food intake.
A Macmillan Dietician was appointed in 2014 to complete a 9-month scoping project to assess dietetic needs across
both Peace Hospice Care and The Hospice of St Francis. Six months into this development the project has highlighted
assessment and education as the priorities for clinical staff. An Expression of Interest proposal for Part 2 of the
Dietetic Pilot Project has been made to Macmillan for approval.
Infection Control
The Hospice has signed a new contract with a different cleaning company starting in April 2014. A rigorous training
and supervision programme has been regularly provided, with clear documentation and an auditable trail to
demonstrate that the Hospice is a clean and safe environment.
2. Clinical effectiveness
In 2014/15 we said we would develop a service for patients with prostate cancer, we would develop a Hospice
Champions Project in Watford General Hospital and introduce Healthcare Assistants into the community team. The
following steps have been taken:
Prostate Cancer Specialist Nurse
In February 2014 a prostate cancer specialist nurse was appointed; this has helped us in our aim of reaching more
patients at an earlier stage in their illness, and providing them with tools to understand and manage their condition
more effectively. The prostate cancer nurse has set up self-management clinics and support groups in collaboration
with Peace Hospice Care which is a neighbouring hospice. This was initially funded by Prostate Cancer UK and is now
a substantive post at The Hospice of St Francis.
Prostate Cancer UK created a video with the Hospice and patients and this was showcased nationally as an
innovative way of reaching more men with prostate cancer.
Hospice Champions Project
This project was a year long collaboration with Peace Hospice Care and West Hertfordshire Hospitals Trust and
aimed to train and support hospice champions on selected wards to affect change at a local ward level and
promote excellent end of life care. During the year, the post holder trained over 500 staff and was able to initiate
the Rose Project within the Trust. This aimed to promote dignity, respect and commpassion at the end of life
through the use of an end of life care symbol, which for the Trust was a pink rose.
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Healthcare Assistants in the Community Team
A business proposal was accepted by our Board of Trustees which supported the introduction of Palliative Care
Healthcare Assistants to provide hands-on care and emotional support to patients and their families who are at
home. This type of care is particularly important at end of life or in a crisis. The Healthcare Assistants have proved to
be an invaluable part of the team enabling the community specialist nurses to focus on more complex problems and
for families to feel more supported at home.
3. Patient experience
In 2014 we said we would develop new ways for patients and their families to feed back their experience of care. As
a result we are now conducting Real Time Reporting surveys and the Fifteen Steps Challenge.
Real Time Surveys
‘Real time” surveys are a short list of easy-to-answer questions to help patients, carers, families and others who use
the services of the Hospice to tell us what they think of the care they receive.
We are doing this:
 To receive feedback on the quality of our care from those who use the Hospice.
 To help us understand how well we are meeting the needs of all our service users.
 To enable us to respond quickly to concerns to improve our care.
 To help us demonstrate the quality of the services we provide.
We carry out this survey using trained volunteers who:
 Can help to complete the form or answer any questions raised.
 Can record answers on paper or an iPad.
 Safeguard anonymity of response, ensuring that there is no obligation on the patient or carer to take part.
 Feed back survey results to the Hospice staff for evaluation and review.
The Fifteen Steps Challenge
The purpose of this tool is a series of questions and prompts to guide you through first impressions of the Inpatient
Unit. The challenge helps gain an understanding of how patients feel about the care provided and how high levels of
confidence can be built.
The tool helps organisations understand and identify the key components of quality care that are important to
patients and carers on their first contact to the Ward.
The purpose of the Fifteen Steps Challenge is to –
 Help staff, patients and other to work together to identify improvements that can be made to enhance the
patients’ experience.
 Provide a way of understanding patients’ first impressions more clearly.
 Provide a method for creating positive improvements in the quality of care through identifying what is
working well and what can be improved.
Associate Members (an identified group of committed volunteers who are advocates for the Hospice) were trained
to complete the Fifteen Step Challenge alongside the Head of Quality and Patient Experience and the Clinical Audit
Nurse Specialist Lead and a Fifteen Step Challenge action plan was devised and presented to the Clinical Leadership
Team. Actions include reviewing the signage to the Hospice in the roads approaching the building and also internal
signage for patients and families within the Hospice.
This challenge will be repeated on a yearly basis.
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This report is based around our 3 main quality indicators:
 Patient Safety
 Clinical Effectiveness
 Patient and Family Experience
1. Patient Safety
a) Incident Reporting
The Hospice has now streamlined the way that all incidents, accidents and near miss events are reported with a new
Incident Reporting Policy. This enables the Hospice to have an improved method of rating each incident in line with
the National Patient Safety Agency matrix. This ensures that team leaders can review the incidents to reduce
recurrance and other associated risks and thereby improve safety.
This new process also ensures that there are mechanisms to report incidents to the right internal groups (and
external agencies) and thereby disceminating lessons learnt throughout the whole organisation including the Board
of Trustees.
b) Mattresses
Following a pressure ulcer review we identified a need to purchase brand new mattresses for the Inpatient Unit. This
was part of a programme to replace all the mattresses, which was completed in March 2015. We sought advice from
the Tissue Viability Nurse team prior to purchase.
2. Clinical Effectiveness
Care Planning and Documentation Review
During 2014/15 we reviewed the way we document care plans and decided to have a mix of electronic and paper to
ensure ease of access for the clinical team while they are caring for patients. The paper copies also provide an
opportunity to discuss individual care plans with patients as well as support the prevention of falls and pressure
ulcers.
Increased access to wellness and palliative rehabilitiation for patients and families.
The Spring Centre had a successful second year in operation. This has been a joint project with Peace Hospice Care,
supported by Macmillan Cancer Support which seeks to support more patients earlier in the palliative trajectory,
promoting wellness and self management. It aims to enable patients and families to have greater resilience in the
face of a serious illness and to enable future planning and better understanding of hospice service for their potential
future use.
2013/14
Average number of patients
using any service/ month = 113
2014/15
Number of patients using any
service/ month = 152
The numbers of patients using our services have steadily risen since opening in 2013 although appears now to have
plateaued in line with our capacity and our vision to expand our services to reach more people, both by facilitating
patients to travel to the Spring Centre, and by working with partners so that our staff can reach patients in different
settings.
Partnership working with Carers in Herts, YMCA and Macmillan CAB enables us to offer opportunities to patients and
carers whom we would otherwise not be able to sustain and we continue to consider further partnerships to enable
sustainability and development.
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Hospice Pharmacist
The Hospice of St Francis appointed a Speciality Pharmacist who has completed a prescribing course to become an
Independent Prescriber. This allows her to prescribe and advise our clinical team on medicine management which
has contributed significantly in patient safety regarding complex medicines and saving costs to the Hospice budget.
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The Pharmacist sees outpatients in the Spring Centre, taking their drug history and monitoring them for any
side effects and any drug interactions.
The Pharmacist advises GPs and the Community Palliative Care Team in the care of patients in their home
focusing on patient medication and compliance.
Herts Neighbours Project
This is a collaborative project led by the Peace Hospice, including Hertfordshire Community Trust, Hertfordshire
Social Services and The Hospice of St Francis following a successful bid for funding from the Cabinet Office from their
End of Life Social Action fund. It is a year long, research based project, which is being evaluated by Lancaster
University. The project aims to recruit and train 60 volunteers who will be matched with people who may be in the
last year of life who require practical assistance or emotional support.
Workforce resilience
Schwartz Center Rounds®
In 2014 we held 5 of these Rounds where clinical staff and volunteers were encouraged to attend. These case
reflections are targeted to discuss and explore how the clinical care scenario made the staff member feel and act. On
average 50 internal and external participants attended each time. Subjects have included:
- Whose bed is it anyway?
- The dilemma of wanting to make things perfect in an imperfect world
- He who shouts the loudest
- When death is all around
- When it’s the small things said or done that have the most impact.
Evidence has shown that Schwartz Center Rounds® result in greater cohesion of teams, along with increased
empathy, staff resilience, and mutual understanding of professional roles. They also provide protected time for staff
to continue their own professional development on the Unit.
Clinical Supervision
Clinical supervision is offered to all of our registered nurses and HCAs (including Bank Staff) using a group supervision
model.
Students at the Hospice
We have increased our student intake from the University of Hertfordshire following the appointment of our
Director of Education and Research in spring 2015.
We have also introduced a rota of medical students allocated to the Medical Director and the team including two
Social Work Students on placement.
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An Audit, Survey & Research Register is maintained and regularly updated, detailing the work that staff at the
Hospice have initiated or are involved in, both internally and externally. All audits are led by the Hospice’s Audit
Clinical Nurse Specialist and are discussed at the Hospice’s Clinical Leadership Team meetings and results are
reported to all relevant staff with action plans in place where necessary.
For the year 1st April 2014 to 31st March 2015, 27 new projects were registered.
Audits included:
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Infection Control
Health and Safety
Medications
Nutrition
Safeguarding
Pain and bowel management
Inpatient admission documentation
Review of patient discharge from Inpatient Unit
REVIEW OF HOSPICE ACTIVITY DATA
Overall Service – Patient Care
Referrals to Inpatient Unit, Community and Spring Centre
% of non cancer diagnosis (new referrals)
Inpatient Unit
Number of admissions
Average length of stay (days)
Spring Centre
Total Attendances
Clinical Nurse Specialist outpatient appointments.
Medical outpatient appointments.
Allied Health Care Professional outpatient appointments.
Community
Community Nurse Specialist domicillary assessments
Medical domicillary assessments.
Allied Health Care Professional domicillary asssessments
Clinical Support Services
Adult bereavement service contacts
Children’s bereavement service contact
Complementary Therapy Contacts
2013/14
2014/15
673
24
700
28
298
13
341
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1765
270
117
511
2980
454
142
803
2325
49
416
2342
35
813
1238
730
319
1283
630
385
The Hospice received two formal complaints during this year and both were concluded in line with the Hospice
Complaints Policy. In both cases, the complainants did not want to take the matter further. Hospice staff have
diseminated the learning from these complaints and, as a result of one of them, invested in extra equipment.
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All accidents, serious incidents, significant events, safety incidents and concerns/constructive comments are
reported using the new Incident Reporting Policy. They are all then graded, registered on a Hospice database and
investigated. Action plans are written for those that are rated Amber or Red, using the National Patient Safety
Agency matrix. Reports are discussed at the Health & Safety Group, Clinical Leadership Team and the Clinical Care
Committee and the Board of Trustees.
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There were 237 completed forms relating to patients, staff, volunteers and families during 1st April 2014 – 31st
March 2015.
Documentation on Crosscare was checked and assessed in all clinical cases and family and carers were made
aware of any incident.
There were no Serious Incidents to report during 1st April 2014 – 31st March 2015.
KEY QUALITY INDICATOR (KQI)
Number of patients who expressed a preference about their preferred place
of death
Complaints
Total number of complaints
Patient Safety
Internal drug incidents/near misses*
Number of slips, trips and falls*
Number of patients with a documented Grade 2 pressure ulcer either on
admission or developed whilst in the Hospice *
Number of patients developing a Grade 3 pressure ulcer within the Hospice
Number of patients admitted with MRSA
Number of patients who developed MRSA during admission
Number of patients admitted with Clostridium Difficile
Number of inpatient who developed Clostridium Difficile
2013/14
94%
2014/15
93%
2
2
18
36
29
21
48
44
0
0
0
1
0
1
0
0
0
0
*The reporting of all clinical incidents has changed from 2014, including falls, medication incidents and pressure
ulcers. The increase in figures during 2014/15, in part, is due to better data collection.
Patient Experience
There is nothing I could add to the treatment I received. Your staff brought me back to the 'land of the
living' and I go on to fight for more days. I have only the highest praise for all staff involved in my case. I
have met a whole team with so much patience. I can't have been easy.
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Carer Experience
The exemplary dignified care given to us all came not only from the medical staff but from everyone - the
cleaners, volunteers, social staff and Chaplain. The medical staff (doctors and nurses) were amazing - we all
knew what was happening and the course of action from the moment we arrived. We never felt there was a
time limit when we were talking to anyone and everyone had time to talk and discuss anything and
everything at any time. The inside and outside spaces are fantastically maintained and helped to make a
bad situation as pleasant as possible.
Patient Experience
Staff are so proactive, reassuring and with a ready smile. The caring attitude of staff - and that includes
volunteers - cannot be "taught" and is a big indication that the right staff are employed (paid or not!).
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For 2015/2016 the Hospice has agreed the following priorities:
PRIORITY 1
Patient Safety
The Hospice plans to upgrade the current call bell system within the Inpatient Unit and the Spring Centre. This
system will ensure that patients get a prompt response when they call for assistance. It will also incorporate new
sensor pads which will alert clinical staff when a patient who has been identified as high risk of falls, is likely to
fall. Hospice clinical staff will review past data about falls and the current Falls Assessment Tool. This will be in
place by December 2015.
PRIORITY 2
Clinical Effectiveness
One of our key aims for 2015/16 is to reach more patients and families. To do this we:
 Plan to invest in community services as part of more collaborative work with local specialist palliative
care providers to promote equality of access to palliative care services in our area.
 Continue to work on identifying gaps in community provision so we can direct wellbeing and
rehabilitation resources to reach more people in the community.
 Develop links with Higher Education Institutions to become research active and improve the evidence
base for our care
 Introduce the national palliative care outcome measures (Outcome Assessment and Complexity
Collaborative OACC)
PRIORITY 3
Patient and Family Experience
During 2015/16 the Hospice plans to:
 Implement the Real Time Reporting that is currently happening in the Inpatient Unit, to those patients
who are seen within the Spring Centre
 Introduce ‘patient panels’ which will be a forum for patients and family members to contribute to service
development
 Work with the CCG and other specialist palliative care providers to design ways to better co-ordinate
community care and access to the IPU beds across Peace Hospice Care and The Hospice of St Francis.
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Care Quality Commission Gives Hospice Top Marks
The Hospice of St Francis received an excellent report from the Care Quality Commission following the most recent
inspection in February 2014.
The Care Quality Commission, which independently checks whether hospices, hospitals, care homes and other
care services are meeting essential standards, concluded that The Hospice of St Francis met all criteria in its
inspection across care and welfare, cleanliness and infection control, staffing, complaints and meeting nutritional
needs.
The report’s overall conclusion was that the Hospice staff were ‘just so caring’. It highlighted that staff and doctors
communicated with people very well, keeping them informed of any changes in their health and wellbeing and
that all staff, from the chef and nurses to the volunteers and doctors, were ‘willing to help’.
The Inspector praised the ‘excellent’ level of care planning at the Hospice, always involving the multidisciplinary
team, the patient and those close to them. This was confirmed by relatives who were interviewed, who stated
that they “never had to explain things twice” to the Hospice team.
The report also noted that the Hospice, which cares for people living with life-shortening illnesses in Herts and
Bucks and supports their families and carers, had comprehensive infection control procedures in place, carrying
out regular checks to ensure everyone was protected against risk of infection.
It also emphasised that the Hospice had enough qualified, skilled and experienced staff, who all underwent
regular competency assessments in key areas of clinical care, to meet people’s needs.
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Healthwatch Hertfordshire’s response to St Francis Quality Account 2014-2015
Healthwatch Hertfordshire is a pleased to submit a response to the Hospice of St Francis Quality
Account. The Account is admirably concise and accessible, setting the context for the document
through an emphasis on the Hospice’s values.
We are pleased to note progress in relation to Priorities for 2014-15, including further
approaches to ensure the cleanliness of the environment and we welcome changes to
approaches to food and mealtimes which allow a greater opportunity to take account of patient
preferences.
The Hospice collaboration with the Peace Hospice and West Herts Hospitals Trust to make
changes at a ward level and promote excellent end of life care is an excellent development. The
adoption of the 15 steps challenge is a useful approach to identifying practical changes that can
be made.
The data in the report shows increasing levels of activity for almost all the Hospice’s activities.
Of particular interest is the number of domiciliary assessments made by allied Health Care
Professional assessments which shows the importance of these posts as part of the team.
The increase in numbers of slips trips and falls is noted and that this is in part due to better data
collection, but welcome the Hospice plans to review falls as part of its priorities for 2015-16.
We also are pleased to see a focus on introducing patient panels as a priority for the coming
year and look forward to seeing how this approach develops.
Michael Downing, Chair Healthwatch Hertfordshire, July 2015
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